Living with disease and disability in the past

Digitised Diseases presents photo-realistic 3D digital models, radiographs and CT scans of pathological lesions and abnormalities in human bone. Those included represent typical specimens of many of the diseases encountered in the skeletal remains of past peoples. Pathological lesions of the skeleton, however, reflect only a small proportion of the spectrum of disease affecting humankind throughout history and are indicative of chronic disease, except for cases of trauma. The majority of diseases affecting people today, as in the past, are associated only with pathological changes in the soft tissues. They usually resolve or cause death of the afflicted long before visible changes develop in bone.

As you use this resource, it should be borne in mind that these pathological specimens belonged to people suffering illness with recognisable symptoms and presenting physical signs of disease. Modern records help us to consider the personal symptoms of pain, fever and immediate disability of specific diseases, and their physical manifestations in living people. The understanding of disease and disability in antiquity has a wide remit incorporating the effect on an individual, on their immediate companions and also on wider society. It involves understanding the physical, psychological and emotional impact of disease and its socio-economic ramifications.

Pathological changes in tissues, both soft and bony, may not have been constant throughout history, but were dependent upon the evolving immune response of the population and upon the evolution of pathogens in a biological ‘arms race’. The clinical presentation of specific diseases may have changed through time. Furthermore, alterations in individual and group economic circumstances, demographic changes and climate all influence the pattern, prevalence and presentation of disease. But, at a personal level, disease must surely have engendered similar physical, psychological and emotional consequences amongst ancient peoples as it does today. The dependence of the afflicted upon others and the need for support must have been the same throughout history. There is little to support any idea of abandonment of the sick in past societies. Fear of contagion has however occasionally engendered harsh and irrational responses to those afflicted with infectious diseases such as leprosy, smallpox and plague. For endemic diseases however it is probable that the essence of human responses to the sick has remained constant and compassionate. It is clear from the unambiguous palaeopathological evidence of long-term survival of the congenitally malformed, of those severely injured and incapacitated and of those with advanced infective, degenerative and malignant disease, that society was frequently supportive and accommodating towards the sick and infirm.

Inherent compassion and the dependence on others for survival, is particularly emotive in the case of young children, infants and neonates. This was almost certainly of greater impact in society in the more distant times of closed isolated communities. In such groups, consanguineous breeding was an accepted necessity uninfluenced by religious and ethical thought. Current studies indicate that a restricted gene pool results in an increased incidence of congenital malformation, phenomena that would have applied also in antiquity. Nevertheless, the evidence of palaeopathology indicates that children with physical change (often termed gross deformities in medicine), such as hydrocephalus, cleft palate, achondroplasia and limb hypoplasias, were nurtured through the neonatal period into infancy and beyond and were supported and cared for during the rest of their lives. Families also valued, cared for and supported those suffering the increasing disability of old age. Although there were proportionally fewer people surviving to old age in antiquity, a traditional care ethic surely existed, as evidenced through findings of relatively elderly individuals throughout history and prehistory.

Medical management in antiquity was not absent or universally ineffective, even if basic and, at times, misguided by 21st century standards. Fracture care was frequently successful with restoration of function. Amputation, presumably therapeutic, was not uncommon and indicates a degree of surgical skill, speed and haemorrhage control and post-operative care in the prevention and management of infection. Even the surgical procedure known as trepanation was seldom fatal, although the rationale of the operation is rarely known.

In Palaeopathology, dealing only with skeletal remains, only a small part of medical practice available to past peoples can be observed. Digitised Diseases, offers the chance to see first-hand pathological lesions in bone, to understand their pathogenesis and, thereby, help others learn about how diseases affect the skeleton. A corollary of this is to propose the likely clinical effects and to better understand the consequences for the individual and their kin. By such means we can gain a better knowledge of the people and of their health and/or suffering in antiquity.

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